|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$11,921.56
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$10,729.40 |
| Rate for Payer: Aetna American Axle |
$7,749.01
|
| Rate for Payer: Aetna Commercial |
$10,133.33
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,749.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cofinity Advantage |
$8,345.09
|
| Rate for Payer: Cofinity Commercial |
$10,252.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,537.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$10,729.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,345.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,941.17
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,133.33
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,941.17
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$10,133.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$7,510.58
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4,410.98
|
| Rate for Payer: VA VA |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,941.17
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$23,843.12
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$21,458.81 |
| Rate for Payer: Aetna American Axle |
$15,498.03
|
| Rate for Payer: Aetna Commercial |
$20,266.65
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,498.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cofinity Advantage |
$16,690.18
|
| Rate for Payer: Cofinity Commercial |
$20,505.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,074.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$21,458.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,690.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,882.34
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,266.65
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,882.34
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$20,266.65
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$15,021.17
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$8,821.95
|
| Rate for Payer: VA VA |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,882.34
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$23,843.12
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,490.97 |
| Max. Negotiated Rate |
$21,458.81 |
| Rate for Payer: Aetna American Axle |
$15,498.03
|
| Rate for Payer: Aetna Commercial |
$20,266.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,498.03
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cofinity Advantage |
$16,690.18
|
| Rate for Payer: Cofinity Commercial |
$20,505.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,074.50
|
| Rate for Payer: Healthscope Commercial |
$21,458.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,690.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,882.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,266.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,882.34
|
| Rate for Payer: PHP Commercial |
$20,266.65
|
| Rate for Payer: Priority Health SBD |
$15,021.17
|
| Rate for Payer: UMR Bronson Commercial |
$10,490.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,882.34
|
|
|
ROMOSOZUMAB-AQQG 105 MG/1.17 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,416.15
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$3,974.53 |
| Rate for Payer: Aetna American Axle |
$2,870.50
|
| Rate for Payer: Aetna Commercial |
$3,753.73
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,870.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$39.24
|
| Rate for Payer: BCN Commercial |
$39.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cofinity Advantage |
$3,091.30
|
| Rate for Payer: Cofinity Commercial |
$3,797.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,532.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$3,974.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,091.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,312.11
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,753.73
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,312.11
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$3,753.73
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health SBD |
$2,782.17
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,633.98
|
| Rate for Payer: VA VA |
$12.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,312.11
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna American Axle |
$2,603.89
|
| Rate for Payer: Aetna American Axle |
$2,870.50
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Commercial |
$3,753.73
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,870.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$39.24
|
| Rate for Payer: BCBS Trust/PPO |
$39.24
|
| Rate for Payer: BCN Commercial |
$39.24
|
| Rate for Payer: BCN Commercial |
$39.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cofinity Advantage |
$3,091.30
|
| Rate for Payer: Cofinity Advantage |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Commercial |
$3,797.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,532.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Healthscope Commercial |
$3,974.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,091.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,312.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,753.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,312.11
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Commercial |
$3,753.73
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health SBD |
$2,782.17
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,482.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,633.98
|
| Rate for Payer: VA VA |
$12.19
|
| Rate for Payer: VA VA |
$12.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,312.11
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,762.64 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna American Axle |
$2,603.89
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Advantage |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$23,199.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
198774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,207.91 |
| Max. Negotiated Rate |
$20,879.82 |
| Rate for Payer: Aetna American Axle |
$15,079.87
|
| Rate for Payer: Aetna Commercial |
$19,719.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,079.87
|
| Rate for Payer: Cash Price |
$18,559.84
|
| Rate for Payer: Cofinity Advantage |
$16,239.86
|
| Rate for Payer: Cofinity Commercial |
$19,951.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,559.84
|
| Rate for Payer: Healthscope Commercial |
$20,879.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,239.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,399.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,719.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,399.85
|
| Rate for Payer: PHP Commercial |
$19,719.83
|
| Rate for Payer: Priority Health SBD |
$14,615.87
|
| Rate for Payer: UMR Bronson Commercial |
$10,207.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,399.85
|
|
|
ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$23,199.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
198774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,583.93 |
| Max. Negotiated Rate |
$20,879.82 |
| Rate for Payer: Aetna American Axle |
$15,079.87
|
| Rate for Payer: Aetna Commercial |
$19,719.83
|
| Rate for Payer: Aetna Medicare |
$11,599.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,079.87
|
| Rate for Payer: BCBS Complete |
$9,279.92
|
| Rate for Payer: Cash Price |
$18,559.84
|
| Rate for Payer: Cofinity Advantage |
$16,239.86
|
| Rate for Payer: Cofinity Commercial |
$19,951.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,559.84
|
| Rate for Payer: Healthscope Commercial |
$20,879.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,239.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,399.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,559.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,719.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,399.85
|
| Rate for Payer: PHP Commercial |
$19,719.83
|
| Rate for Payer: Priority Health SBD |
$14,615.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,079.87
|
| Rate for Payer: UHC Core |
$12,087.10
|
| Rate for Payer: UHC Exchange |
$9,117.52
|
| Rate for Payer: UMR Bronson Commercial |
$8,583.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,399.85
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Advantage |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Advantage |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.94
|
| Rate for Payer: UHC Core |
$185.11
|
| Rate for Payer: UHC Exchange |
$139.63
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 68462025301
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UMR Bronson Commercial |
$115.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 68462025301
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$137.13
|
| Rate for Payer: UHC Exchange |
$103.44
|
| Rate for Payer: UMR Bronson Commercial |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 60687057711
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Advantage |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Exchange |
$1.40
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
NDC 60687057711
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Advantage |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 16729023401
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 62332003231
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$137.13
|
| Rate for Payer: UHC Exchange |
$103.44
|
| Rate for Payer: UMR Bronson Commercial |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 00904599601
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.54 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$171.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Advantage |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.30
|
| Rate for Payer: UHC Core |
$178.18
|
| Rate for Payer: UHC Exchange |
$134.41
|
| Rate for Payer: UMR Bronson Commercial |
$126.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 16729023401
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00904599601
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Advantage |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 62332003231
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UMR Bronson Commercial |
$115.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
ROPIVACAINE 0.2 % FOR NERVE BLOCK INJECTION
|
Facility
|
OP
|
$122.04
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
161560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna American Axle |
$79.33
|
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$61.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: BCBS Complete |
$48.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$45.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.53
|
|
